I note you have not as yet received a reply to your last post so will try to be helpful. I assume Dad had the TRUS biopsy which in the UK at least generally comprises 8-12 cores. Perhaps a minority of men find this a rather painful but the majority feel the experience and after effects not too bad. I had 12 cores taken and was able to carry on as normal and there was only a trace of blood in my urine for a couple of days after the procedure. However, I can well believe that 23 cores would be more painful. I would have thought that Dad might best revert to the Doctor for more effective pain alleviating medication. Because the cores in the TRUS procedure are taken through the rectum, some men develop a urinary infection which can be painful and sometimes quite difficult to overcome with antibiotics.
When you are contacted with the biopsy result I would ask that you be told in simple terms where and how extensive the cancer was. Is it proposed to do a scan in due course if one has not already been done? (There is usually about about 6-8 weeks before a scan is done after biopsy to allow the the Prostate to heal so a good image can be obtained). When all the diagnostic tests are done - the extent of these may vary in the US from in the UK., you could ask what treatment options are being offered in Dad's case and what is recommended. With a man having a PSA of the order of 150 in the UK scans might not be given and the man just started on HT for example. Treatment would be changed/augmented depending on the particular type of cancer and the individual's response.
I believe Ketone levels are to do with the amount of fat but suggest you ask the significance of this for your Dad